The broad clinical phenotype of Type 1 diabetes at presentation
Division of Endocrinology, Diabetes and Metabolism, Ulm University Medical Center, Ulm, Germany.Diabetic Medicine (Impact Factor: 3.12). 10/2012; 30(2). DOI: 10.1111/dme.12048
Immune-mediated (auto-immune) Type 1 diabetes mellitus is not a homogenous entity, but nonetheless has distinctive characteristics. In children, it may present with classical insulin deficiency and ketoacidosis at disease onset, whereas autoimmune diabetes in adults may not always be insulin dependent. Indeed, as the adult-onset form of autoimmune diabetes may resemble Type 2 diabetes, it is imperative to test for diabetes-associated autoantibodies to establish the correct diagnosis. The therapeutic response can be predicted by measuring the levels of autoantibodies to various islet cell autoantigens, such as islet cell antibodies (ICA), glutamate decarboxylase 65 (GAD65), insulin, tyrosine phosphatase (IA-2) and IA-2β, and zinc transporter 8 (ZnT8) and evaluating β-cell function. A high risk of progression to insulin dependency is associated with particular genetic constellations, such as human leukocyte antigen risk alleles, young age at onset, the presence of multiple autoantibodies, including high titres of anti-GAD antibodies; such patients should be offered early insulin replacement therapy, as they respond poorly to diet and oral hypoglycaemic drug therapy. Hence, considering the broad spectrum of phenotypes seen in adult-onset diabetes, treatment targets can only be reached by identification of immune-mediated cases, as their management differs from those with classical Type 2 diabetes. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.
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ABSTRACT: Aims: To assess the frequency and severity of diabetic ketoacidosis (DKA) at disease onset in children newly diagnosed with autoimmune type 1 diabetes (T1D) in Istanbul in the last decade. Also, to evaluate the potential contribution of the national diabetes awareness programme (NDAP) initiated in 2010. Methods: Four hundred and one consecutive children (mean ± standard deviation, age 8.1 ± 4.1 years) with a diagnosis of autoimmune T1D were evaluated retrospectively with respect to demographic, clinical, and laboratory data in relation to DKA at disease onset. The possible impact of NDAP on the rate of DKA at disease onset in the last 2 years was also evaluated by comparing the data related to the time intervals before and after the onset of the programme. The results were evaluated at 95% confidence interval and significance was granted for p ≤ 0.05. Results: The overall frequency of DKA at disease onset was 44.2%, with a significant trend for decline in rate of DKA at disease onset in the last decade (p=0.0001). There were no significant differences in proportions of newly diagnosed T1D patients with severe or moderate DKA over time. Mean body mass index standard deviation score tended to increase in the last decade, but not significantly (p=0.09). When the time intervals before and after the onset of NDAP were evaluated, there was a more than two-fold decrease in rate of DKA (from 49.3% to 23.9%) (p<0.0001). Conclusions: The frequency of a DKA event at onset of T1D is still high in Istanbul children despite a decreasing trend in the last decade. NDAP may significantly contribute to the reduction in rate of DKA.Journal of pediatric endocrinology & metabolism: JPEM 06/2013; 26(11-12):1-7. DOI:10.1515/jpem-2013-0060 · 1.00 Impact Factor
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ABSTRACT: Historically, type 2 diabetes (T2D) was considered a metabolic disease of ageing. However, recent discoveries have demonstrated the role of chronic systemic inflammation in the development of insulin resistance and subsequent progression to T2D. Over the years, investigations into the pathophysiology of T2D have identified the presence of islet‐specific T cells and islet autoimmune disease in T2D patients. Moreover, the cell‐mediated islet autoimmunity has also been correlated with the progressive loss of β‐cell function associated with T2D disease pathogenesis. In this manuscript, the involvement of cell‐mediated islet autoimmune disease in the progression of T2D disease and the similarities in islet‐specific T‐cell reactivity between type 1 diabetes (T1D) and T2D are discussed.Diabetes Obesity and Metabolism 09/2013; 15(s3). DOI:10.1111/dom.12167 · 6.36 Impact Factor
Article: Actualités sur l’acidocétose[Show abstract] [Hide abstract]
ABSTRACT: This review presents several hot topics in the field of ketoacidosis, including epidemiology, new causes, new diagnostic tools and treatment protocols. This work is based on systematic reviews, consensus and recommandations. Among the discussed topics are the new forms of ketoacidosis, including fulminant diabetes and ketosis-prone type 2 diabetes, the new place of capillary dosage of beta-hydroxybutyrate, the role of insulin analogs and recommandations for perfusions.Journal Europeen des Urgences et de Reanimation 10/2013; 25(s 3–4):163–169. DOI:10.1016/j.jeurea.2013.07.001
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